Family / Time > Teenagers, Boys, Girls
Why Teenagers Act Crazy
By RICHARD A. FRIEDMAN
NYT JUNE 28, 2014
teenage years USA
Silver, 11, July 2018
’My ambition is to help the world in all its conflict.
So there are little things you can do like save the
and then there are big things like speaking up for the people
who have been hurt.
I would like to do things that give other people a voice’
Photographs by Carolyn Mendelsohn
Being Inbetween: girls of our time – in pictures
A series documenting and exploring
the lives of girls aged between 10 and 12;
a time of transition between girlhood and young adulthood.
Winning the portrait series of the Julia Margaret Cameron
Award this year,
three portraits were also selected as winners
in the British Journal of Photography Openwalls Arles
‘This work and the way it is exhibited
is my way of exploring the lives of these girls,
giving them power and allowing their voices to be heard.
It is celebrating the beauty that is wholly them,
one that is sometimes concealed in silence,
attitude, embarrassment and self-consciousness,”
the photographer, Carolyn Mendelsohn, said.
Fri 31 Jul 2020 09.00 BST
teen girls USA
Illustration: Gary Panter
Why Teenagers Act Crazy
By RICHARD A. FRIEDMAN
NYT JUNE 28, 2014
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Family / Time > Teenagers, Boys, Girls
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Why Teenagers Act Crazy
JUNE 28, 2014
The New York Times
SundayReview | Opinion
By RICHARD A. FRIEDMAN
ADOLESCENCE is practically synonymous in our culture with risk
taking, emotional drama and all forms of outlandish behavior. Until very
recently, the widely accepted explanation for adolescent angst has been
psychological. Developmentally, teenagers face a number of social and emotional
challenges, like starting to separate from their parents, getting accepted into
a peer group and figuring out who they really are. It doesn’t take a
psychoanalyst to realize that these are anxiety-provoking transitions.
But there is a darker side to adolescence that, until now, was poorly
understood: a surge during teenage years in anxiety and fearfulness. Largely
because of a quirk of brain development, adolescents, on average, experience
more anxiety and fear and have a harder time learning how not to be afraid than
either children or adults.
Different regions and circuits of the brain mature at very different rates. It
turns out that the brain circuit for processing fear — the amygdala — is
precocious and develops way ahead of the prefrontal cortex, the seat of
reasoning and executive control. This means that adolescents have a brain that
is wired with an enhanced capacity for fear and anxiety, but is relatively
underdeveloped when it comes to calm reasoning.
You may wonder why, if adolescents have such enhanced capacity for anxiety, they
are such novelty seekers and risk takers. It would seem that the two traits are
at odds. The answer, in part, is that the brain’s reward center, just like its
fear circuit, matures earlier than the prefrontal cortex. That reward center
drives much of teenagers’ risky behavior. This behavioral paradox also helps
explain why adolescents are particularly prone to injury and trauma. The top
three killers of teenagers are accidents, homicide and suicide.
The brain-development lag has huge implications for how we think about anxiety
and how we treat it. It suggests that anxious adolescents may not be very
responsive to psychotherapy that attempts to teach them to be unafraid, like
cognitive behavior therapy, which is zealously prescribed for teenagers.
What we have learned should also make us think twice — and then some — about the
ever rising use of stimulants in young people, because these drugs may worsen
anxiety and make it harder for teenagers to do what they are developmentally
supposed to do: learn to be unafraid when it is appropriate to do so.
As a psychiatrist, I’ve treated many adults with various anxiety disorders,
nearly all of whom trace the origin of the problem to their teenage years. They
typically report an uneventful childhood rudely interrupted by adolescent
anxiety. For many, the anxiety was inexplicable and came out of nowhere.
OF course, most adolescents do not develop anxiety disorders, but acquire the
skill to modulate their fear as their prefrontal cortex matures in young
adulthood, at around age 25. But up to 20 percent of adolescents in the United
States experience a diagnosable anxiety disorder, like generalized anxiety or
panic attacks, probably resulting from a mix of genetic factors and
environmental influences. The prevalence of anxiety disorders and risky behavior
(both of which reflect this developmental disjunction in the brain) have been
relatively steady, which suggests to me that the biological contribution is very
One of my patients, a 32-year-old man, recalled feeling anxious in social
gatherings as a teenager. “It was viscerally unpleasant and I felt as if I
couldn’t even speak the same language as other people in the room,” he said. It
wasn’t that he disliked human company; rather, socializing in groups felt
dangerous, even though intellectually he knew that wasn’t the case. He developed
a strategy early on to deal with his discomfort: alcohol. When he drank, he felt
relaxed and able to engage. Now treated and sober for several years, he still
has a trace of social anxiety and still wishes for a drink in anticipation of
Of course, we all experience anxiety. Among other things, it’s a normal
emotional response to threatening situations. The hallmark of an anxiety
disorder is the persistence of anxiety that causes intense distress and
interferes with functioning even in safe settings, long after any threat has
We’ve recently learned that adolescents show heightened fear responses and have
difficulty learning how not to be afraid. In one study using brain M.R.I.,
researchers at Weill Cornell Medical College and Stanford University found that
when adolescents were shown fearful faces, they had exaggerated responses in the
amygdala compared with children and adults.
The amygdala is a region buried deep beneath the cortex that is critical in
evaluating and responding to fear. It sends and receives connections to our
prefrontal cortex alerting us to danger even before we have had time to really
think about it. Think of that split-second adrenaline surge when you see what
appears to be a snake out on a hike in the woods. That instantaneous fear is
your amygdala in action. Then you circle back, take another look and this time
your prefrontal cortex tells you it was just a harmless stick.
Thus, the fear circuit is a two-way street. While we have limited control over
the fear alarm from our amygdala, our prefrontal cortex can effectively exert
top-down control, giving us the ability to more accurately assess the risk in
our environment. Because the prefrontal cortex is one of the last brain regions
to mature, adolescents have far less ability to modulate emotions.
Fear learning lies at the heart of anxiety and anxiety disorders. This primitive
form of learning allows us to form associations between events and specific cues
and environments that may predict danger. Way back on the savanna, for example,
we would have learned that the rustle in the grass or the sudden flight of birds
might signal a predator — and taken the cue and run to safety. Without the
ability to identify such danger signals, we would have been lunch long ago.
But once previously threatening cues or situations become safe, we have to be
able to re-evaluate them and suppress our learned fear associations. People with
anxiety disorders have trouble doing this and experience persistent fear in the
absence of threat — better known as anxiety.
Another patient I saw in consultation recently, a 23-year-old woman, described
how she became anxious when she was younger after seeing a commercial about
asthma. “It made me incredibly worried for no reason, and I had a panic attack
soon after seeing it,” she said. As an older teenager, she became worried about
getting too close to homeless people and would hold her breath when near them,
knowing that “this was crazy and made no sense.”
B. J. Casey, a professor of psychology and the director of the Sackler Institute
at Weill Cornell Medical College, has studied fear learning in a group of
children, adolescents and adults. Subjects were shown a colored square at the
same time that they were exposed to an aversive noise. The colored square,
previously a neutral stimulus, became associated with an unpleasant sound and
elicited a fear response similar to that elicited by the sound. What Dr. Casey
and her colleagues found was that there were no differences between the subjects
in the acquisition of fear conditioning.
But when Dr. Casey trained the subjects to essentially unlearn the association
between the colored square and the noise — a process called fear extinction —
something very different happened. With fear extinction, subjects are repeatedly
shown the colored square in the absence of the noise. Now the square, also known
as the conditioned stimulus, loses its ability to elicit a fear response. Dr.
Casey discovered that adolescents had a much harder time “unlearning” the link
between the colored square and the noise than children or adults did.
IN effect, adolescents had trouble learning that a cue that was previously
linked to something aversive was now neutral and “safe.” If you consider that
adolescence is a time of exploration when young people develop greater autonomy,
an enhanced capacity for fear and a more tenacious memory for threatening
situations are adaptive and would confer survival advantage. In fact, the
developmental gap between the amygdala and the prefrontal cortex that is
described in humans has been found across mammalian species, suggesting that
this is an evolutionary advantage. This new understanding about the
neurodevelopmental basis of adolescent anxiety has important implications, too,
in how we should treat anxiety disorders. One of the most widely used and
empirically supported treatments for anxiety disorders is cognitive behavior
therapy, a form of extinction learning in which a stimulus that is experienced
as frightening is repeatedly presented in a nonthreatening environment. If, for
example, you had a fear of spiders, you would be gradually exposed to them in a
setting where there were no dire consequences and you would slowly lose your
arachnophobia. The paradox is that adolescents are at increased risk of anxiety
disorders in part because of their impaired ability to successfully extinguish
fear associations, yet they may be the least responsive to desensitization
treatments like cognitive behavior therapy precisely because of this impairment.
This presents a huge clinical challenge since young people are generally risk
takers who are more prone to exposure to trauma as a direct result of their
behavior, to say nothing of those who were exposed to the horrors of the wars in
Iraq and Afghanistan or the mass shootings like those in Newtown and Aurora.
Many of them will go on to develop post-traumatic stress disorder, which is
essentially a form of fear learning. Now we have good reason to think that
exposure therapy alone may not be the best treatment for them. A recent study of
children and adolescents with anxiety disorders found that only 55 to 60 percent
of subjects responded to either cognitive behavior therapy or an antidepressant
alone, but 81 percent responded to a combination of these treatments. And in
another study, there was preliminary evidence that adolescents responded less
well to cognitive behavior therapy than children or adults.
This isn’t to say that cognitive therapy is ineffective for teenagers, but that
because of their relative difficulty in learning to be unafraid, it may not be
the most effective treatment when used on its own.
And there is potentially something else to worry about with our anxious
adolescents: the meteoric rise in their use of psychostimulants like Ritalin and
Adderall. In theory, stimulants could have a negative impact on the normal
developmental trajectory of anxious teenagers.
According to the health care data company IMS Health, prescription sales for
stimulants increased more than fivefold between 2002 and 2012. This is of
potential concern because it is well known from both human and animal studies
that stimulants enhance learning and, in particular, fear conditioning.
Stimulants, just like emotionally charged experiences, cause the release of
norepinephrine — a close relative of adrenaline — in the brain and facilitate
memory formation. That’s the reason we can easily forget where we put our keys
but will never forget the details of being assaulted.
Might our promiscuous use of stimulants impair the ability of adolescents to
suppress learned fear — something that is a normal part of development — and
make them more fearful adults? And could stimulants unwittingly increase the
risk of PTSD in adolescents exposed to trauma? In truth, we haven’t a clue.
But we do know this: Adolescents are not just carefree novelty seekers and risk
takers; they are uniquely vulnerable to anxiety and have a hard time learning to
be unafraid of passing dangers. Parents have to realize that adolescent anxiety
is to be expected, and to comfort their teenagers — and themselves — by
reminding them that they will grow up and out of it soon enough.
Richard A. Friedman is a professor of clinical psychiatry and the director of
the psychopharmacology clinic at the Weill Cornell Medical College.
A version of this op-ed appears in print on June 29, 2014, on page SR1 of the
New York edition with the headline: Why Teenagers Act Crazy.
Why Teenagers Act Crazy,
Girl who ran away from home
after row found dead in forest
· Body discovered three weeks after disappearance
· Police not treating death of 15-year-old as suspicious
Tuesday September 25, 2007
The family of the missing Hampshire schoolgirl Rosemary Edwards were told
yesterday that the body of a young woman found in the New Forest was that of the
missing girl. Police who had been searching for the 15-year-old, who disappeared
from the family home after an argument three weeks ago, said they were not
treating the death as suspicious.
Rosemary's father, David, said the family were "completely shell-shocked" by
the discovery of the body.
Speaking from his home in Dibden Purlieu, which borders the New Forest, Mr
Edwards, a computer programmer, told the local Daily Echo: "Rosemary touched so
many people's lives. It seems impossible to believe she was so low that she felt
life wasn't worth living."
On a newspaper message site that the family had used to publicise Rosemary's
disappearance, her mother, Jennifer, wrote: "People look for blame and answers
but sometimes there is no one to blame. Some questions can never be answered."
A keen horse rider and talented student who already had a GCSE A-grade in maths
and a B in art, Rosemary had been due to return to school on the day she went
missing. Her body was found by two walkers on Sunday in an area of the New
Forest known as Busketts Lawn Inclosure, near Bartley, 10 miles from her home.
The discovery came just days after a £100,000 reward was offered for the
teenager's safe return.
Rosemary's brother, Robert, 19, posted a tribute to his sister on the Facebook
website. He said: "Rosemary had a fantastically good 15 years of life and will
be missed by all, especially her friends and family. We don't know what could
have happened in Rosemary's life to lead her to the circumstances that have
occurred. But I know deep down that she knew that so many people loved her and
cared for her."
Rosemary had not been seen since 10.30pm on Tuesday September 4, when she went
to her bedroom after an argument with her parents. They had banned her from
horse riding and other activities after finding out she had lied over how she
lost her part-time job in a shop.
Mr Edwards, who was the last to see her when he went to her bedroom to say
goodnight, has written of his regret at their last conversation together and his
torment in blaming himself for her disappearance and of the events that led up
Writing on an internet forum before his daughter's body was found, he said:
"Rosemary told us she had left her part-time job, but we later found out that
she had been sacked for a minor transgression which shocked her employer and us
because it was so totally out of character.
"As parents, we didn't want this to be the start of Rosemary going off the
rails, so we imposed a short ban on accessing the internet and a longer ban on
He later realised, from texts and emails he had found, that she was going
through "some kind of torment in her head ... I played the blame game for the
first few days, but it is very self-destructive, on top of all the other
He said that when he last saw her he asked for a hug, but she refused. He then
gave her a kiss on the cheek. He added: "I wish I'd said how much I loved her,
but how many other parents do this constantly just in case it could be the last
time you see your son or daughter?"
Police said a post mortem examination was being carried out yesterday.
Girl who ran away from
home after row found dead in forest,
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